Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on ...in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.
We diagnosed 66 peripheral nerve injuries in 34 patients who survived severe coronavirus disease 2019 (COVID-19). We combine this new data with published case series re-analyzed here (117 nerve ...injuries; 58 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (25.1%), common fibular (15.8%), sciatic (13.1%), median (9.8%), brachial plexus (8.7%) and radial (8.2%) nerves at sites known to be vulnerable to mechanical loading. Protection of peripheral nerves should be prioritized in the care of COVID-19 patients. To this end, we report proof of concept data of the feasibility for a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.
Abstract Osteogenesis imperfecta (OI) is one of the most common inherited bone disorders. These individuals are high-risk for developing fractures during their lifetime secondary to bone fragility. ...This case presents a female with type I OI involved in a high speed motor vehicle accident resulting in a traumatic spinal cord injury (SCI) and paraplegia. Inpatient rehabilitation was complicated by fractures of the femur and lumbar spine which impacted her level of independence upon discharge to prevent additional fractures and maintain safety. OI coupled with SCI creates a difficult combination for the rehabilitation team. This case highlights the complexity of this challenge to bring awareness to the rehabilitation team in order to safely maximize independence and minimize and prevent unnecessary injury when designing an interdisciplinary treatment plan. Level of Evidence To be determined.
While on our general inpatient rehabilitation floor, a 58-year-old man with no hematologic or dermatologic history developed an erythematous patch on his medial ankle that turned more purpuric, with ...a slight orange tint, and was associated with mild pruritus. The diagnosis of exercise-induced vasculitis was made after initially being mistaken for cellulitis. This common exanthem is often misdiagnosed. Due to its association with exercise, the physiatrist should be aware of its presence in both the inpatient and outpatient settings.
Objective To investigate the benefits of comprehensive inpatient rehabilitation for patients after left ventricular assist device (LVAD) implantation. Design A retrospective cohort study. Setting An ...urban academic inpatient rehabilitation hospital. Patients This study included 58 patients admitted to inpatient rehabilitation after LVAD implantation between 2009 and 2012. Methods Chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after LVAD implantation was performed. Main Outcome Measurements Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency. Results The study included 47 male and 11 female patients ages 21.8-84.1 years (mean standard deviation {SD}, 64.2 ± 11.2 years). The mean (SD) length of time between LVAD implantation and admission to rehabilitation was 27.0 ± 15.3 days. Twenty-one patients (36%) required transfer to an acute care hospital. Ten patients returned after transfer and completed inpatient rehabilitation. For the 47 total patients who completed inpatient rehabilitation, the mean (SD) length of stay was 20.3 ± 10.8 days (range, 7-50 days). Mean (SD) admission and discharge FIM scores were 68.4 ± 13.6 and 91.7 ± 11.8, respectively, with a mean (SD) difference between admission and discharge FIM scores of 23.4 ± 11.2. The mean (SD) FIM efficiency was 1.33 ± 0.65. Complications during rehabilitation included anemia that required transfusion, respiratory distress, epistaxis, gout flare, automated implantable cardioverter defibrillator firing, and gastrointestinal bleeding. Conclusions Patients with LVADs demonstrate functional gains in inpatient rehabilitation. However, there is a high incidence of complications in this population, which often requires transfer to an acute care setting.
The transition of graduate medical education to competency-based education systems has resulted in exploration of the efficacy of Entrustable Professional Activities (EPAs) and related Observable ...Practice Activities (OPAs) as evaluation tools. EPAs were introduced to PM&R in 2017, but no OPAs have been reported for a non-procedurally based EPA. The primary aims of this study were to create and form consensus on OPAs for the Spinal Cord Injury EPA.
A Modified Delphi panel of seven experts in the field was utilized to gain consensus on ten PM&R OPAs for the Spinal Cord Injury EPA.
After the first round of evaluations, most OPAs were evaluated by experts as requiring modifications (30/70 votes to keep, 34/70 votes to modify) with a majority of comments focusing on the specific content of the OPAs. Edits were made, and after the second round, the OPAs were evaluated and determined to be kept (62/70 votes to keep, 6/70 votes to modify) with most edits being about semantics of the OPAs. Ultimately, there was significant difference in all three categories between round 1 and round 2 (P < 0.0001) and 10 OPAs were finalized for use.
This study created 10 OPAs that can potentially help provide targeted feedback to residents on their competency in caring for patients with spinal cord injury. With regular usage, OPAs are designed to provide residents with insight into how they are progressing towards independent practice. In the future, studies should aim to assess the feasibility and utility of implementing the newly developed OPAs.
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